Carpal Pain

A restful sleep is invaluable. But for many people it’s often not easy to get. When it comes to being productive, the cloudy feeling that comes from getting less than your required rest prevents you from performing at your top level.

A comprehensive look into just how important it is to get the recommended six to eight hours every night was compiled by the Atlantic. They showed evidence that suggests the lack of sleep can cause a wide array of chronic health problems, like hypertension, weight gain, diabetes, bipolar disorder, and psychosis. Because of sleep's important role in the regulation of hormones like dopamine, epinephrine, and serotonin, sleep loss can wreak havoc on your emotional well-being, often resulting in symptoms that resemble those of manic depression.

In patients who have been sleep deprived for long periods of time, as well as those who get between four and six hours of sleep for days on end, there are serious impacts to cognitive function like concentration and memory as well as the immune system.

Those who suffer from chronic pain, like from carpal tunnel syndrome, are usually sleep deprived. Whether the pain can rob you of sleep or the lack of sleep makes the pain worse is not understood. Pain and sleep are connected, says sleep expert Dr. David Neumeyer. Chronic pain is very common in the population and even more common in people who have poor sleep. That forms a vicious cycle because pain affects your ability to sleep, and the lack of sleep makes the pain seem worse.

Precisely how sleep and pain are connected varies from person to person. You must determine if the pain is a manifestation of a sleep disorder or if the pain is made worse by the poor quality of sleep.

It’s hard to improve sleep in people with chronic pain because they often don’t want to (or just cannot) take any more pain drugs. And of course, most such drugs like Aleve, Tylenol, and Advil are not intended for chronic use. Many of these individuals are already taking medications to treat their pain disorder. Further, certain prescription sleeping pills can interact with their pain medications, making the health situation much worse.

If you have hand pain and other problems in your fingers, hand or wrist, then it could be due to one of several conditions developing deep inside your hand and wrist. The list below describes the most common hand pain conditions and what causes them.

Carpal Tunnel Syndrome

Unlike RSI, carpal tunnel syndrome is NOT a repetitive strain injury. However, it seems to occur with greater prevalence in certain jobs that require a lot of hand activities. It is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatized. 

It’s actually considered a disease with no known cause. Carpal tunnel syndrome symptoms develops when the median nerve (located inside of the wrist) becomes compressed. This produces feelings of pain, burning, numbness and tingling within the fingers (especially the thumb, but not the pinky), hand and wrist. 

Early onset usually starts with numbness and tingling in the hand and fingers. Patients generally report waking up at night to shake out their numb hand and fingers. The range of motion and grip strength of the hand may also be affected.

Repetitive Strain Injury (RSI)

RSI is also known as repetitive stress injury, repetitive motion injury, repetitive motion disorder, cumulative trauma disorder, occupational overuse syndrome, overuse syndrome, or regional musculoskeletal disorder. It represents an injury of the musculoskeletal and portions of the nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression or sustained or awkward positions. 

RSI can occur just about anywhere in the body, but when it afflicts the hands there are many related symptoms. These may be pain or soreness in the hand, wrist, and forearm that keeps occurring. You may also experience tingling, numbness, coldness, loss of sensation, loss of grip strength, lack of endurance, weakness, and fatigue. The muscles in your forearms might feel hard and wiry. While you lie in bed you could experience pain or numbness. 

Wrist Tendonitis

Wrist tendonitis is one of the most common types of repetitive strain injury. Tendonitis also may affect parts of the body other than the hand, where it would e called shoulder tendonitis or ankle tendonitis, for instance. Wrist tendonitis occurs when a tendon within the wrist and forearm becomes inflamed and swollen. And since tendons are present throughout the body, such inflammation can occur just about anywhere. 

Wrist tendonitis commonly develops as a result of active participation in sports or simply using the hands either repeatedly or forcefully. The sport most commonly associated with wrist tendonitis is rock climbing, where the tendonitis is most pronounced in the fingers. Also, office workers, jackhammer users, hairdressers, assembly line workers, cashiers, and transcriptionists are also highly susceptible to this condition.

Wrist Tenosynovitis

Wrist tenosynovitis is a type of repetitive strain injury that is similar to wrist tendonitis in a number of ways. As opposed to an inflammation of the tendon as in tendonitis, those with tenosynovitis develop an inflammation of the fluid-filled sheath that surrounds the tendon. More often than not, cases of tenosynovitis develop within the fingers, and the syndrome is known as “trigger finger”. 

Those with a case of wrist tenosynovitis may experience limited range of motion within the fingers, and may feel a cracking occurring when they try to straighten their affected fingers. High risk jobs that require repetitive hand and finger movements are associated with wrist tenosynovitis. These include secretarial jobs, assembly work, meat packing, and various warehouse occupations.

DeQuervain’s Syndrome

DeQuervain’s syndrome is also known as BlackBerry thumb, gamer's thumb, washerwoman's sprain, radial styloid tenosynovitis, de Quervain disease, de Quervain's tenosynovitis, de Quervain's stenosing tenosynovitis, mother's wrist, or mommy thumb. It is a type of repetitive strain injury that primarily affects the thumb. Two tendons that control the movement of the thumb contain sheaths which envelop the tendons. When the sheaths become inflamed, pain and swelling may occur within the thumb. 

People with DeQuervain’s syndrome may experience symptoms such as a lack of ability to grip with the affected thumb. The thumb may be painful or tender, and there might be swelling over the thumb side of the wrist.

What To Do

For any of these conditions, you must attack the root cause of the problem, which is tendon inflammation. To permanently relieve the inflammation you must drain the fluid causing the swelling and also break the adhesions that cause that inflammation. 

If you have carpal tunnel syndrome, you must know these two well-known key facts:

FACT 1: The National Institutes of Health says you must be sure you actually need surgery in the first place. Along with American Academy of Orthopedic Surgeons, they state that most people who get carpal tunnel surgery actually don't need it. 

Instead, patients should have used non-surgical alternatives. They recommend surgery should be your absolute last option once you've tried everything else.

FACT 2: Carpal tunnel surgery has a high failure rate. Over 50% of patients are unsatisfied with their results. That’s mostly because pain is not completely resolved or pain returns shortly after. 

If your'e feeling symptoms like hand or finger pain, numbness and tingling, then you might be seeing the start of carpal tunnel syndrome. Several elements contribute to your risk of getting this condition. The major factors listed below weigh heavily in your risk of getting it.

Sex

Women make up about 70% of carpal tunnel syndrome cases. The highest frequency of carpal tunnel syndrome is among pregnant women, or women of menopausal age who are obese, diabetic and smokers. Middle-aged women have a significantly higher risk for carpal tunnel syndrome than middle-aged men. In fact, it’s so common among women that carpal tunnel is arguably a woman’s condition.

Family History

There is little doubt that you’re genetically predisposed to having carpal tunnel syndrome. This suggests a hereditary factor which causes a cascade of events inside the carpal tunnel to produce carpal tunnel syndrome. If a close relative like a parent or sibling has carpal tunnel syndrome, your chances of also having it are greatly increased.

Obesity

Obesity is a contributing factor in having carpal tunnel syndrome. In fact, losing weight can reverse symptoms. A 10-month aerobic exercise program significantly improves nerve function and reduces symptoms in patients. As patients lose weight, the improved circulation and increased oxygen consumption causes symptoms to decline significantly. Also, diabetes, which tends to be more common among obese people, is considered to amplify the risks for having carpal tunnel syndrome.

General Health

Clinical research has shown that a shortage of vitamin B6 and vitamin C could be a factor in developing carpal tunnel syndrome. This is why it advisable for people with carpal tunnel syndrome symptoms to take these vitamins as supplements. Other contributing health factors of carpal tunnel syndrome can include rheumatoid arthritis, hypothyroidism, and smoking.　

Psychology

Psychologists tell us that carpal tunnel syndrome patients generally appear to be somewhat emotionally stressed or frustrated. They tend to be people who have been unable to attain what they want in life, whether it’s been a new home or a new job, etc. After psychotherapy that helped them to overcome their psychological barriers, the carpal tunnel syndrome symptoms tended to clear up. While this concept is controversial, many adherents to the idea are adamant about this cause and effect relationship.

Your Job

Any effective remedy for carpal tunnel syndrome get to the actual problem in your wrist. That’s tendon inflammation which causes swelling. Any and all essentials for carpal tunnel therapy should include this. Carpal tunnel surgery doesn’t do this. That’s why pain returns after a 1-2 years in most cases.

The following are two essentials for carpal tunnel you should do to permanently get rid of carpal tunnel symptoms. They are important because they attack the root cause of the problem (tendon inflammation and swelling) inside the wrist joint.

1. Perform stretching exercise. Stretching your fingers, hand and wrist is a good way to break apart the adhesions that make tendons “sticky”. That stickiness is the ultimate cause of inflammation. Once the tendons become more supple, they glide smoother and will no longer inflame and swell. Good stretching exercises are not difficult or time consuming to do. You can see some of the best carpal tunnel exercises here.

2. Myofascial release massage your wrist and forearm. This technique is best performed by therapists. It pumps out excess fluid build-up around swollen tendons in the wrist joint.As a result, pressure is removed from the median nerve. This massage must be performed at least once daily for periods of 2 to 4 weeks to be effective.  

Dr. S. Brunetti and colleagues set out to study aspirin and carpal tunnel surgery. Specifically, they wanted to know if patients should stop aspirin before carpal tunnel surgery. They theorized it let to too many complications.

Do you have carpal tunnel syndrome or wrist tendonitis? This free self-test can tell the difference.

The researchers studies 150 patients who underwent standard open carpal tunnel release under intravenous anesthesia. They were divided into three groups: groups 1 and 2 (50 patients each) were on aspirin 100 mg for at least 1 year. 

In group 1 the aspirin was never stopped. In group 2 aspirin was stopped at least 5 days before surgery and resumed 3 days after. Group 3 acted as a control (50 patients) who did not take aspirin. The incidence of clinically significant complications was recorded. Patients were reviewed at 2, 14 and 90 days post- surgery.

The researchers discovered there was no difference in the incidence of complications in the 3 groups. They concluded that continuation of aspirin did not increase the risk of complications. It is therefore unnecessary to stop aspirin before standard open carpal tunnel release so long as good surgical techniques are used.

Source:

While some doctors prefer to modify the following carpal tunnel surgery post-op instructions. In general, they are instructions given by most surgeons after carpal tunnel surgery.

Do you have carpal tunnel syndrome or wrist tendonitis? This self-test can tell the difference.

Motion, Elevation and Use

After surgery, it is very important to prevent stiffness and swelling. Thus, immediately after carpal tunnel you must try to make a full fist and fully straighten your fingers ten times per hour while you’re awake.  This will also help prevent scar tissue from forming around the median nerve.  This exercise will not pull out your stitches but the motion will drive the fluid out of your fingers and thus prevent stiffness, swelling or other complications.  

Elevating your hand is important after carpal tunnel surgery to prevent any swelling.  Your hand should be kept at a level higher than your heart in order to cause excess fluid to drain from your hand.  You may use your hand for light activities like eating, dressing, toileting and personal care.  You may drive once you feel strong enough to grip the steering wheel safely and without too much pain.

Your Bandage

Don’t change your bandage or splint after surgery until the first post-operative visit with your doctor.  The bandages must be kept dry, so showering should be done with a plastic bag over your arm and hand that’s securely taped just beneath the shoulder. 

Pain Medicines

After surgery that’s been performed under local anesthesia (or local anesthesia with sedation), it is very common to experience tingling and numbness in your hand for 8-10 hours, or longer.  A prescription for a pain killer will be given to you after the surgery for you to take at home. Frequently, only one or two pills will be needed.  The most important way to relieve pain after hand surgery is constant elevation of your hand.

Scar Management and Stitches

Dr. Elisa Yao and colleagues report on a clinical trial comparing acupuncture for carpal tunnel syndrome with placebo treatment.

This self-test can tell if you have carpal tunnel syndrome or wrist tendonitis?

Objective: To investigate the efficacy of acupuncture for the treatment of mild to moderate carpal tunnel syndrome.

Design: Prospective, randomized, placebo-controlled, double-blinded study.

Setting: Single-center study.

Participants: Forty-one acupuncture-naïve adult subjects with mild to moderate carpal tunnel syndrome enrolled in the study. Thirty-four subjects completed the study.

Methods: Diagnosis of carpal tunnel syndrome was supported by EMG findings. Subjects were randomly assigned to either (1) acupuncture or (2) placebo acupuncture using placebo acupuncture needles. Both groups received weekly sessions of acupuncture for 6 weeks. Wrist braces were provided to both groups to wear at night, and compliance was monitored.

Main Outcome Measurements: The primary outcome measurement was subject reported change in the Carpal Tunnel Self-Assessment Questionnaire (CTSAQ) Symptom and Function scales immediately after and at 2 weeks and 3 months after the final treatment. The secondary outcomes included tip and key pinch strength and combined sensory index.

Results: Compared with baseline values, subjects in the acupuncture group did not show significant improvement on the CTSAQ Symptom scale score at 3 months after the last treatment.

Conclusions: This study is the clinical trial to study acupuncture for carpal tunnel syndrome . Both the treatment and placebo groups demonstrated improvements from baseline. Acupuncture was NOT shown to be superior to placebo acupuncture for patients with mild to moderate carpal tunnel syndrome. Instead, massage of the wrist and forearm was far superior to any other non-surgical therapy.

Source:

Understanding everything about wrist tendonitis can start by an analogy. Imagine what happens when a ship is tied to a dock during a storm. The rope holding the ship to the dock strains with all the wave action. The straining is basically what happens with tendonitis.

Do you have carpal tunnel syndrome or wrist tendonitis? This free self-test can tell the difference.

Tendons are like ropes that hold muscles to bones. When a tendon is overworked and strained it can inflame. Doctors call this tendonitis.  It can occur anywhere in the body but most often occurs near a joint, particularly the shoulders, elbows, wrists and heels. That’s because these areas of the body are prone to repetitive strain. And repetitive strain is the most common cause of tendonitis. 

When the covering (or sheath) of the tendon is also inflamed, which usually happens, this is called Tenosynovitis. Tendonitis and tenosynovitis normally occur simultaneously. For most practical purposes, we can discuss both as tendonitis.

Tendonitis goes by many names depending on where it occurs. Therefore, Tennis Elbow, Golfer’s Elbow, Pitcher’s Shoulder, Swimmers Shoulder and Jumper’s Knee are all forms of tendonitis. Tendonitis may be associated with other diseases such as arthritis, diabetes, and thyroid disease. 

There are a number of risk factors for wrist tendonitis but the most common are repetitive strain, incorrect posture, poor stretching or conditioning before physical activity, abnormal bone or joint (as in unequal leg length), and stresses from other conditions like arthritis, gout or thyroid disorders. If left untreated, long-term structural abnormalities can result, leading to chronic pain and severe disability. 

The signs and symptoms of wrist tendonitis occur either where the tendon attaches to the bone or along its length. Symptoms include pain (usually a dull ache), tenderness and mild swelling. In severe cases, wrist tendonitis can result in a small tear or complete rupture of the tendon, requiring surgery, but this is rare.

Most cases of wrist tendonitis will respond well to home self-care measures. The most common cases of wrist tendonitis are treated very successfully with the following: 

Rest the wrist joint. This means doing nothing with your hand. That may be hard if you work, but it must be done to get rid of symptoms. Splint your hand at night to avoid unconscious over-bending.

Avoid activities that aggravate the symptoms. Don’t do whatever caused the pain to begin with, like typing too much.

Filling Workers Comp claims for carpal tunnel syndrome can be daunting. But it’s something that MUST be done for many people whose lives are turned upside down by this condition. 

Many people are not able to work due to symptoms of carpal tunnel syndrome. Many of these people may be able to receive compensation through Workers Compensation or unemployment insurance.

Do you have carpal tunnel syndrome or wrist tendonitis? This self-test can tell the difference.

Most states cover carpal tunnels injuries as long as it's determined the injury is related to the person’s job. Even though many occupations are considered high risk jobs for this condition, the process may not always be simple. The applicant’s medical history might be carefully inspected to determine if other factors exist which might have contributed to the worker’s injury.

Denial of Claim

It’s likely that some insurers will try to avoid paying for carpal tunnel syndrome injury claims because it’s hotly debated whether this condition is actually a work-related injury. Just how willing an insurer is to provide coverage for carpal tunnel syndrome will partly depend on state workers compensation laws in addition to the specific insurer.

Insurers may do one of the following: 1. deny a claim initially, 2. attempt to prove the injury is not related to the employee’s work, or 3. may accuse the applicant of fabricating their carpal tunnel syndrome. Several insurers have pressured lawmakers to limit (or even eliminate) coverage for carpal tunnel syndrome claims. 

Studies show that steroids shots help carpal tunnel. When a steroid is injected into the wrist, it can temporarily relieve carpal tunnel syndrome symptoms. Two injections probably do not help more than one injection.

Do you have carpal tunnel syndrome or wrist tendonitis? Take this self-test to tell the difference.

For years, a typical treatment to relieve carpal tunnel syndrome is to inject a corticosteroid right into the carpal tunnel. Corticosteroids are synthetic hormones that reduce inflammation.

Investigators looked at the results of clinical trials to see how effective such steroid injections really are. They compared local steroid injections either with other non-surgical treatments or with an injection that had no steroid (a placebo) in it. They wanted to see how often the injections worked and how long the pain-relief lasted. They also wanted to know how injections compared to other treatments.

They found two trials showed steroid injections reduced symptoms more than placebo after two weeks. Another study showed that two injections given eight weeks apart had the same effect as one single injection.

In one trial they found evidence that steroid injections were similar to corticosteroid pills during the short term. But they appeared to be more effective up to 3 months. But this advantage does not last long because 20 months after treatment there is no difference in improvement between those given injections versus those given pills. 

Another study showed that a local injection was better than a systemic injection (i.e., injected into a muscle instead of the carpal tunnel). Two trials showed no difference between local steroid injections and anti-inflammatory drugs with wrist splints.

Bottom Line: Steroid shots help relieve carpal tunnel pain. However, long term results are not promising. In addition, most people can only have up to three steroid shots over five years. That’s due to the risk of serious side effects.

Source:

Sponsored by the Carpal Rx

The major types of anesthetics used for general anesthesia in order to have carpal tunnel release surgery are inhalation anesthetics and intravenous anesthetics. Each has its own risks and benefits, and you should talk to your doctor to know what you will have.

Do I really need carpal tunnel surgery?

Inhalation anesthetics are sometimes also known as volatile anesthetics. They are drugs that enter the blood stream via the lungs and then carried around the body. Inhalation anesthetics are not commonly used by themselves. Instead, they are often used with other intravenous anesthetics. A combination of inhalation plus intravenous anesthetics are sometimes used with opioid drugs (to relieve pain) and neuromuscular blockers (to temporarily paralyze muscles. This is called balanced anesthesia.

Do you have carpal tunnel syndrome or wrist tendonitis? Take this free self-test to tell the difference.

Common inhalation anesthetics include:

Halothane   

Enflurane

Isoflurane

Nitrous oxide

Sevoflurane

Desflurane

Common intravenous anesthetics include:

Ketamine

Methohexital

Etomidate

Propofol

Sponsored by the Carpal Rx

Sponsored by the Carpal Rx

There are 4 stages of general anesthesia that help doctors to better predict the course of your carpal tunnel surgery events, from anesthesia “induction” to “emergence”.

Do you have carpal tunnel syndrome or wrist tendonitis? Take this free self-test to tell the difference.

Stage I: This starts with the induction of anesthesia. It ends with loss of consciousness in the patient. The patient can still feel pain in this stage and the actual carpal tunnel release surgery does not yet begin.

Stage II: Also called REM stage, it includes occasionally dangerous responses to stimuli during carpal tunnel surgery. These include vomiting or uncontrollable movement. This stage is usually shortened by giving the patient a barbiturate (like sodium pentothal) prior to giving the anesthetic agent.

Stage III: The surgical anesthesia stage where the patient's pupils are constricted and gaze is central. This is the desired depth of the surgical anesthesia. In this stage the muscles relax and breathing gets regular. Eye movements also stop. This is where the actual carpal tunnel release surgery actually takes place.

Stage IV: This is a super-deep stage of carpal tunnel surgery where the patient is overdosed. Highly dangerous, it is marked by a drop in blood pressure or even circulatory failure. Death can result if the patient is not quickly revived.

Sponsored by the Carpal Rx

Sponsored by the Carpal Rx

Dr. M.P Nancollas and colleagues report on long term results of carpal tunnel release in the Journal of Hand Surgery (Br. 1995 Aug;20(4):470-4). To determine the long-term results of carpal tunnel release surgery, they retrospectively reviewed 60 cases, an average of 5.5 years after surgery.

(Do you have carpal tunnel syndrome or wrist tendonitis? Take this free self-test to tell the difference.)

About 87% reported a good overall outcome; the average time to maximum improvement of symptoms was 9.8 months. However, 30% reported poor to fair strength and long-term scar discomfort, and 57% noted a return of some pre-operative symptoms, most commonly pain, beginning an average of 2 years after surgery. They found no correlation between pre-operative symptoms or extent of surgical dissection (surgical extent) and outcome.

Carpal tunnel syndrome was job related in 42%; of these, 26% changed from heavy to lighter work following surgery. Although occupational cases were slower to improve and remained off work longer, the long-term subjective results were the same for both groups. They found significant morbidity from the surgical scar and decreased strength, and often considerable delay until ultimate improvement, especially in patients with job-related carpal tunnel syndrome.

Overall, the statistics gathered from these researchers confirm that carpal tunnel release surgery is a poor treatment for carpal tunnel syndrome.

Sponsored by the Carpal Rx

Sponsored by the Carpal Rx

Many workers get carpal tunnel syndrome from performing the duties associated with their jobs. As their carpal tunnel syndrome worsens, they are unable to perform these jobs and often require time off of work or changes in their duties.

(Do you have carpal tunnel syndrome or wrist tendonitis? Take this free self-test to tell the difference.)

While Workman's Compensation should normally pay for time off of work and health-related benefits, this is not always the case.

When it comes to workman's compensation and carpal tunnel syndrome, there are 3 important facts to keep in mind:

--When compared to back injuries, carpal tunnel syndrome cases are actually more likely to result in lost time claims

--Women suffer from carpal tunnel syndrome more frequently than men

--Workers who file carpal tunnel injury claims are usually paid higher than workers who file back injury claims

The average cost per carpal tunnel claim is about $16,000. This is the amount of money Workman’s Compensation pays on average for carpal tunnel claims. When a worker has an attorney, however, this average jumps to nearly $30,000.

 Sponsored by the Carpal Rx

Sponsored by the Carpal Rx

Do you have hand pain? Wrist pain? Numbness or tingling? Do these symptoms wake you up from your sleep? You might have carpal tunnel syndrome. This painful condition can be caused by one of several factors. But you might be surprised to know that one of the factors causing it can be a dysfunction in your spine.

(Be sure you don’t have wrist tendonitis instead of carpal tunnel syndrome – take a self-test to tell the difference.)

Spinal subluxations are specific misalignments of the spinal vertebrae, most commonly in the lower cervical spine. That misalignment can cause swelling in the nerves responsible for carrying sensory impulses from the wrist and hand.

Thus, while the carpal tunnel deep inside the wrist may be perfectly normal, an irritated or inflamed nerve at the spine can make it feel as though the pain originates from the fingers, hand or wrist. In addition, this nerve irritation can produce inflammation (swelling) in the muscles and other tissues that it supplies all along the nerve's length in the arm. This can make the muscles and tendons hypersensitive, and that can result in abnormal tension in the forearm. In the end, the resulting mechanical forces produced by spinal misalignment can be the root cause the carpal tunnel syndrome symptoms.

Sponsored by the Carpal Rx